Dr. Mugyenyi Discusses Potential Perils of Health System Strengthening at the Expense of HIV/AIDS

The most griping message from Dr. Peter Mugyenyi this week was, of course, his stories about HIV patients in desperate need of treatment being turned away, including pregnant and breastfeeding women who risked passing the deadly virus on to their babies. As director of Uganda’s Joint Clinical Research Center, the largest PEPFAR implementer in East Africa, Dr. Mugyenyi painted a heart-wrenching image of patients who had been promised treatment going from one clinic to another, only to be told there would be no open slots until a currently enrolled patient died.

But another vital perspective that got less attention in Dr. Mugyenyi’s meetings this week with members of Congress, the Executive Branch, and the press, was that the idea of health systems strengthening—at least as its being conceived in Washington today—may actually undermine, rather than bolster, the gains made in fighting AIDS.

Why? Dr. Mugyenyi says we must go back to the 1990s in Africa, before the historic roll out of antiretroviral treatment in the developing world, when HIV was a death sentence.

“In the 1990s, you just couldn’t strengthen health systems because they were clogged … Clogged with AIDS patients,” he said. He recalled serving as the head of a children’s ward in one of Uganda’s main hospitals and he said the entire ward was filled with sick, dying children. When they tested for HIV, 100 percent of the children were found to be positive.

“If you went to the surgical ward, it was the same. If you went to the medical ward, it was the same,” he said. “What happened to the other diseases? Had they gone into recession? Of course not.” They had simply been displaced by the mayhem and crisis created by AIDS.

Dr. Mugyenyi and others meet with Rep. McDermott

Today, when he goes to a medical ward in a hospital, patients with those other diseases are there, being successful treated and cured, because the AIDS patients are no longer filling all the beds.

Any effort to strengthen health systems, Dr. Mugyenyi said, “must be focused to the realities on the ground.” Those realities include AIDS being a continuing, consuming crisis that the world cannot afford to turn away from. An effort to strengthen health systems is welcome, he said, but not if it takes away from the focus on combating AIDS.

Dr. Mugyenyi was in Washington this past week for a series of meetings with policymakers, advocates, and the press, in a trip organized by the Center for Global Health Policy and several other groups. This is part of the Global Center’s efforts to make the voices of developing country physicians heard in American policy debates.

Click here to see a video interview with Dr. Mugyenyi or here to read a VOA story highlighting his concerns. This Huffington Post blog also takes a wider view of the messages Dr. Mugyenyi brought to Washington this week.